San Francisco hep B free: a grassroots community coalition to prevent hepatitis B and liver cancer.

Chronic hepatitis B is the leading cause of liver cancer and the largest health disparity between Asian/Pacific Islanders (APIs) and the general US population. The Hep B Free model was launched to eliminate hepatitis B infection by increasing hepatitis B awareness, testing, vaccination, and treatment among APIs by building a broad, community-wide coalition. The San Francisco Hep B Free campaign is a diverse public/private collaboration unifying the API community, health care system, policy makers, businesses, and the general public in San Francisco, California. Mass-media and grassroots messaging raised citywide awareness of hepatitis B and promoted use of the existing health care system for hepatitis B screening and follow-up. Coalition partners reported semi-annually on activities, resources utilized, and system changes instituted. From 2007 to 2009, over 150 organizations contributed approximately $1,000,000 in resources to the San Francisco Hep B Free campaign. 40 educational events reached 1,100 healthcare providers, and 50% of primary care physicians pledged to screen APIs routinely for hepatitis B. Community events and fairs reached over 200,000 members of the general public. Of 3,315 API clients tested at stand-alone screening sites created by the campaign, 6.5% were found to be chronically infected and referred to follow-up care. A grassroots coalition that develops strong partnerships with diverse organizations can use existing resources to successfully increase public and healthcare provider awareness about hepatitis B among APIs, promote routine hepatitis B testing and vaccination as part of standard primary care, and ensure access to treatment for chronically infected individuals.

Logistics of community smallpox control through contact tracing and ring vaccination: a stochastic network model.

BACKGROUND: Previous smallpox ring vaccination models based on contact tracing over a network suggest that ring vaccination would be effective, but have not explicitly included response logistics and limited numbers of vaccinators. METHODS: We developed a continuous-time stochastic simulation of smallpox transmission, including network structure, post-exposure vaccination, vaccination of contacts of contacts, limited response capacity, heterogeneity in symptoms and infectiousness, vaccination prior to the discontinuation of routine vaccination, more rapid diagnosis due to public awareness, surveillance of asymptomatic contacts, and isolation of cases. RESULTS: We found that even in cases of very rapidly spreading smallpox, ring vaccination (when coupled with surveillance) is sufficient in most cases to eliminate smallpox quickly, assuming that 95% of household contacts are traced, 80% of workplace or social contacts are traced, and no casual contacts are traced, and that in most cases the ability to trace 1-5 individuals per day per index case is sufficient. If smallpox is assumed to be transmitted very quickly to contacts, it may at times escape containment by ring vaccination, but could be controlled in these circumstances by mass vaccination. CONCLUSIONS: Small introductions of smallpox are likely to be easily contained by ring vaccination, provided contact tracing is feasible. Uncertainties in the nature of bioterrorist smallpox (infectiousness, vaccine efficacy) support continued planning for ring vaccination as well as mass vaccination. If initiated, ring vaccination should be conducted without delays in vaccination, should include contacts of contacts (whenever there is sufficient capacity) and should be accompanied by increased public awareness and surveillance.

Risk behaviors and HIV incidence among repeat testers at publicly funded HIV testing sites in San Francisco.

OBJECTIVE: More than 25% of HIV tests are for individuals who have previously been tested. To characterize repeat testers, we 1) estimated the seroincidence of HIV infection, stratified by risk behavior, and examined the association between 2) testing rates and risk level and 3) repeat testing and tester characteristics. METHODS: Records from HIV counseling and testing (C&T) sites were reviewed. Seroincidence was estimated by linking results of current test with date of last reported HIV negative test. A risk hierarchy of behaviors was created. Repeat testing rates were calculated for each risk level strata. Multivariate models explored the association of repeat testing with tester characteristics. RESULTS: The HIV seroincidence among repeaters was 1.3 per 100 person-years (range 0.7-7.0 per 100 person-years). The high-risk level subject had a repeater rate of 92%, with 5.3 tests/person and was more likely (odds ratio = 4.96, 95% confidence interval 3.8-6.5) to have tested two or more times, compared with those in the low risk group. CONCLUSION: The highest users of repeat testing are those who are practicing the highest risk behaviors and have the highest incidence of HIV. This suggests that prevention messages should be modified to more explicitly address the behaviors that are putting individuals at high risk for HIV.